Male fertility restored through simple surgery

A new study presented this week at the Radiological Society of North America conference in Chicago showed that a minimally invasive surgical procedure may help restore male fertility.

Some experts believe that male infertility is commonly caused by the formation of varicose veins in the testicle, called varicoceles. These are a tangled network of blood vessels which form due to blood circulation problems. They are believed to be relatively common with around 10-15 per cent of men being affected. In many cases they cause no adverse effects, however it is thought they may allow warm blood to pool in the testicle, increasing the scrotum temperature and reducing sperm count and motility.

The traditional treatment for problematic varicoceles has been open surgery, but recently the less invasive procedure, varicocele embolisation, has emerged. The procedure involves inserting a small catheter into the varicocele through a small nick in the skin of the groin. A special fluid can then be injected which blocks off the vein and diverts blood flow through an alternative route.

The study included 223 infertile men aged 18-50 with as least one varicocele, all of whom had healthy partners and were trying to achieve pregnancy. A semen analysis performed on 173 patients three months after the procedure showed that on average, sperm motility and sperm count had significantly improved. Sebastian Flacke, assistant professor of radiology at the University of Bonn in Germany, who led the research, said 'We found that spermatic vein embolism combined with anti-inflammatory treatment improves sperm motility and sperm count in infertile men with varicoles'. Dr Flacke said 'Six months after treatment 26 per cent of couples had achieved pregnancy'.

Dr Allan Pacey, a male fertility expert from Sheffield University told the BBC that 'Varicoceles are common in men, but whether or not they actually cause fertility problems has been controversial'. He said 'A recent systematic review of seven randomised controlled trials concluded that there was no improvement to fertility by correcting the varicocele by surgery, although most of the studies considered used the old technique rather than embolisation'. He pointed out that the authors had not compared their sperm data and fertility rates to a control group of infertile men with varicoceles who had not undergone the procedure, which 'makes it very difficult to conclude how successful the embolisation technique has really been at restoring fertility'.